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Related Experiment Videos

Recurrent sustained ventricular tachycardia. 4. Pleomorphism

M E Josephson, L N Horowitz, A Farshidi

    Circulation
    |March 1, 1979
    PubMed
    Summary
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    Chronic ventricular tachycardia often presents with multiple morphologies, frequently originating from left ventricular aneurysms. These distinct patterns, including right and left bundle branch block, can be triggered by stimulation, suggesting reentry mechanisms.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Cardiac Surgery

    Background:

    • Chronic sustained ventricular tachycardia (VT) can exhibit diverse electrocardiographic morphologies.
    • Understanding the mechanisms and origins of morphologically distinct VTs is crucial for effective management.

    Purpose of the Study:

    • To investigate the occurrence and characteristics of morphologically distinct ventricular tachycardias in patients with chronic sustained VT.
    • To explore the relationship between pleomorphic VT, left ventricular aneurysms, and underlying reentry mechanisms.

    Main Methods:

    • Electrophysiologic study (EPS) in 14 patients with chronic sustained VT.
    • Analysis of spontaneous and induced VT morphologies, including right bundle branch block (RBBB) and left bundle branch block (LBBB).

    Related Experiment Videos

  • Epicardial mapping and assessment of diastolic fragmented activity to identify reentry circuits.

    • Main Results:

    • 13 out of 14 patients exhibited both RBBB and LBBB morphologies during EPS.
    • Multiple VT morphologies were observed spontaneously in 4 patients and inducible in all 14.
    • Left ventricular origin, often within an aneurysm, was identified in 12 patients for both RBBB and LBBB.
    • Reentry mechanisms were implicated in the generation of different VT morphologies.

    Conclusions:

    • Ventricular tachycardia is frequently pleomorphic, displaying multiple distinct morphologies.
    • Variable exit sites or activation sequences during the same tachycardia likely explain the observed morphological variations.
    • A significant association exists between pleomorphic VT and left ventricular aneurysms, suggesting aneurysms as a common substrate.